Free healthcare for all

Founded in 1948 by the Labour government of Clement Attlee and his Health Minister Aneurin "Nye" Bevan, the NHS operates on the principle of providing free healthcare to all those who require it irrespective of their wealth and social background.

Today, the service employs more than a million people and is considered a national institution by most Britons.

As the general election approaches, around half of the country considers its fate the top issue heading into the vote, according to polling company YouGov.

Roberta Bivins, a cultural historian of the NHS at Warwick University, told Al Jazeera the service carries a deeper significance for Britons than just providing free treatment.

"Since its origins in 1948, the NHS has been taken as the living symbol of the nation's commitment to 'equalitarianism', to the idea of a society in which all citizens are equally able to achieve their fullest potential," she said.

Since the NHS operates as the symbol and guarantor of equality, at least in terms of healthcare, the perception that it is threatened brings with it considerable anxiety, and prompts passionate debate.

Roberta Bivins, Warwick University

The British public has been repeatedly exposed to claims that the NHS is under threat, she explained, adding that as a result there is a fear that the country may one day end up with a system like the one in the US.

"Popular culture often suggests that the only alternative to the NHS is US-style private medicine, with all its inequalities of access and health outcomes.

"Since the NHS operates as the symbol and guarantor of equality, at least in terms of healthcare, the perception that it is threatened brings with it considerable anxiety, and prompts passionate debate."

That fear of a US-style system was evident in conversations with Awan, who used the example of the recent Manchester bombing to stress the importance of what the NHS provides.

"One thing that really hit me after the bombing was an American who put up a very poignant post online. That if the victims of this horrible atrocity had been in America, the families wouldn't just be dealing with the awful incident," she said.

"Within 24 hours they would have received an ambulance bill and [been] asked 'Are you insured for this procedure?'.

"What happened in our city really makes me value the NHS."

Doctors and analysts warn that morale is low within the NHS owing to mismanagement and government policy [File:EPA]

Privatisation fears

The extent to which the British healthcare system is moving towards the US model is the subject of intense debate in the UK.

Current Health Secretary Jeremy Hunt was one of the co-authors of a policy book titled Direct Democracy: An Agenda For A New Model Party, which called for the "de-nationalisation" of the NHS and its replacement with an insurance-based system, such as in the US.

Hunt denies that he is a supporter of a privatised healthcare system and the Conservatives have pledged annual real-term increases for the NHS, but critics say the size of the increase is the lowest it has been since the service was founded.

In the financial year ending in 2010, 111.7bn pounds ($144bn) was spent on the NHS, and the 2021 budget is set to be 126.5bn pounds ($163bn).

The King's Fund, a charity working to improve healthcare in the UK, says spending on the NHS grew roughly four percent a year from its establishment until 2010.

After the Conservatives came to power, that yearly increase will average 1.1 percent between 2010 and 2021.

The charity warns that as demand for services continues to grow, there will be increasing pressure on the NHS owing to insufficient funding.

Bad policy and mismanagement

New York University's Andrew Seaton, a historian of the NHS, said the British healthcare system is not alone in facing challenges and that its problems had both a domestic and international dimension.

"The increased technologisation of medicine, rising expectations by individuals as to what care they deserve to receive, the shift from acute disease to morbid disease, particularly cancer, being among the primary causes of mortality, and longer average life expectancies have all combined to push up medical costs throughout the world," he said.

The NHS is an institution that regularly polls higher than the Armed Forces and Royal Family as the thing that makes people most 'proud' to be British, so there's a great deal of goodwill to draw on in addressing its problems.

Andrew Seaton, New York University

These, he added, were problems that transcended the funding models countries used, whether they be insurance-based or state-funded.

Domestically, he said there were "particular dynamics within the British system that help or hinder" the situation of the NHS, one of which is the service's reliance on the state to underwrite most of its spending.

"Historically, Labour governments have proved far more willing to pump money into the NHS than the Conservatives, especially under the Blair and Brown Labour governments between 1997 and 2010," Seaton said, adding that increased spending had brought about higher patient satisfaction.

But money alone does not account for the difficulties, according to Seaton, with bad policy and mismanagement also factors.

"The Conservative Health and Social Care Act 2012 was the most sweeping transformation of the NHS since its birth, costing millions that could have been more wisely spent elsewhere," he said.

"Seven years of Conservative government have demoralised many working within the service," he added. But he didn't reserve his criticism for the Conservatives alone.

"On the other side, the Labour Party have been weak since they left government and have not articulated a clear vision for the service or held the government suitably to account for their failings. There is a vacuum of leadership on this issue."

For Seaton, predictions about the end of the NHS are premature owing to the level of feeling the British people have towards it, nevertheless he said there was a need to boost its finances.

"The NHS is an institution that regularly polls higher than the Armed Forces and Royal Family as the thing that makes people most 'proud' to be British, so there's a great deal of goodwill to draw on in addressing its problems."

Critics warn a lack of funds will put more pressure on the NHS as demand for its services grows [Neil Hall/Reuters]